Fertility care expectations: what do PLHIV and health care providers in Jamaica know about assisted reproduction services for safe conception?

Increased life expectancy among persons living with HIV (PLHIV) has increased the desire for parenthood. It is therefore important that PLHIV and health care providers (HCPs) are aware of the available assisted reproduction services (ARS) for PLHIV facing infertility or unsuppressed viremia. Through secondary data analysis we identified PLHIV who were actively trying to conceive and their knowledge of ARS. As specialized fertility care for PLHIV is managed by Obstetrician/Gynecologists (Ob/Gyns), they were surveyed regarding their attitudes towards working with PLHIV and their awareness and knowledge of ARS with a self-administered questionnaire. In this cross-sectional study, 251 PLHIV and 102 Ob/Gyns were recruited and interviewed using a semi-structured questionnaire. Although most Ob/Gyns (81%) reported being supportive of PLHIV having children, 85% counseled against pregnancy, particularly persons in HIV serodifferent relationships. Significantly more PLHIV under 40 years compared to those over 40 years had heard about ARS (59% vs. 43%, p = .007). Ob/Gyns were more knowledgeable of expensive ARS, while PLHIV's knowledge was more restricted to cheaper more accessible ones. In conclusion Ob/Gyns knowledge gaps and underlying stereotypes may present barriers to PLHIV's uptake of ARS. Additionally, virologically unsuppresed persons in HIV serodifferent relationships may be vulnerable as Ob/Gyns were less supportive of them.

Living with the Threat of Covid-19: Exploring the Psychological Impact of Covid-19 in Those who Conceived Through ART Versus Spontaneously.

OBJECTIVES: To explore and compare anxiety relating to the threat of Covid-19 in pregnancy by women who conceived through assisted reproductive technology (ART) and spontaneously. We also examined the psychological coping strategies used and lived experience for both groups. METHODS: A total of 21 women who conceived through ART at a private university based IVF and a matched sample of women who conceived spontaneously were enrolled from July 2020 to February 2021. This was a mixed methods study. Covid-19-specific anxiety was measured using the coronavirus anxiety scale (CAS) as well as a validating qualitative data model with the use of open-ended questions to expand on quantitative findings. RESULTS: In both groups of women the level of anxiety detected by the CAS was low and mixed coping strategies (emotion-focused and problem-solving) were utilized. The ART group expressed more positive feelings towards pregnancy during the Covid-19 pandemic. CONCLUSION: The vulnerable ART group is no more at risk for negative emotional well-being during the Covid-19 pandemic. Additionally, healthcare providers ought to be knowledgeable of various Covid-19 coping strategies that may provide emotionally protective measures for all women of reproductive age. This is of particular importance as effective coping may ultimately prevent disruptions that could compromise prenatal care during the covid-19 pandemic.

Mental Health Awareness and Counseling Practice of Jamaican Clergy: An Exploratory Study.

Clergy play a vital role in mental health care in Jamaica but little is known about their mental health awareness and practices. Thirty five Anglican and Baptist clergy were compared to 24 helping professionals and 67 community members using purposive sampling. Clergy's awareness exists with spiritualized beliefs about the etiology of mental illness as well as with effective and unethical counseling practices. Findings indicate the need for more training in mental health sensitization and practice.

Reproductive needs of PLHIV in Jamaica: relationship between fertility desire, motives and depression.

Background/objective: Advances in antiretroviral therapy and assisted reproduction technology which allow for longer and healthier lives and safer conception options necessitate a new understanding of the sexual and reproductive needs of persons living with HIV (PLHIV). This study examines fertility desire and motives for having children among PLHIV in Jamaica and explores the association with depressive symptoms.Methods: In a cross-sectional study, 251 PLHIV in their reproductive years voluntarily completed an interviewer-administered questionnaire. SPSS analyses involved bivariate and logistic regression models significant at p < .05.Results: A desire to have children was expressed by 66% (n = 166), mostly males and persons younger than 40 years. Of those in a current relationship (n = 126), not having previous children best predicted fertility desire (p = .001; CI 0.04-0.44) as well as motives to conceive (p = .02; CI 0.01-0.66). PLHIVs in their reproductive years who are at depression risk are those in a sero-discordant relationship (p = .01; CI 1.48-30.22) and who have been diagnosed between 1 and 4 years (p = .05; CI 0.01-1.04).Conclusions: HIV status does not dampen the desire to have future children. There is need to evaluate the sexual, reproductive and mental health needs of PLHIV.

Archival data review of intimate partner homicide-suicide in Jamaica, 2007 - 2017: focus on mental health and community response.

OBJECTIVE: To identify social and behavioral patterns and mental health concerns associated with intimate partner homicide-suicide (IPHS) in Jamaica through an analysis of media and police reports. METHODS: This was an archival data review of police records and print, radio, and television reports of IPHS incidents from January 2007 - June 2017 in Jamaica. The 27 cases found were qualitatively analyzed using pre-identified codes and open coding to generate themes and patterns. RESULTS: A prevalence rate of 0.1 per 100 000 was determined. In all cases, males were the homicide-offender. Sociodemographic patterns associated with IPHS incidents-age, personality traits, choice of weapon, and time of occurrence-were consistent with previous findings. Common triggers were offender obsession, sexual jealousy, and fear of separation. Despite reports of mental health concerns in both male and female partners, neither the couples nor community members sought help prior to the homicide-suicide. CONCLUSION: These findings demand a change in cultural attitudes toward domestic disputes and mental health concerns, and a redefining of the community's responsibility in IPHS. The warning signs associated with IPHS should be part of existing violence and suicide prevention programs.

Tridimensional acculturation and adaptation among Jamaican adolescent-mother dyads in the United States.

A bidimensional acculturation framework cannot account for multiple destination cultures within contemporary settlement societies. A tridimensional model is proposed and tested among Jamaican adolescent-mother dyads in the United States compared to Jamaican Islander, European American, African American, and other Black and non-Black U.S. immigrant dyads (473 dyads, M adolescent age = 14 years). Jamaican immigrants evidence tridimensional acculturation, orienting toward Jamaican, African American, and European American cultures. Integration is favored (70%), particularly tricultural integration; moreover, Jamaican and other Black U.S. immigrants are more oriented toward African American than European American culture. Jamaican immigrant youth adapt at least as well as nonimmigrant peers in Jamaica and the United States. However, assimilated adolescents, particularly first generation immigrants, have worse sociocultural adaptation than integrated and separated adolescents.

Detecting depression during pregnancy and associated lifestyle practices and concerns among women in a hospital-based obstetric clinic in Jamaica.

OBJECTIVE: Antenatal depression, despite its association with increased maternal morbidity risks, is understudied in the developing world. We determined the rate and predictors of depression throughout pregnancy and the use of medication in women attending an obstetric clinic. METHOD: Prospective longitudinal study of 452 women newly registered at the antenatal clinic at the University Hospital of the West Indies between September 2005 and February 2006. Sociodemographic data, clinical information and self reports of depression using Edinburgh Postnatal Depression Scale (EPDS) were gathered over three trimesters. RESULTS: On average, 25% of women were identified as having a probable depressive disorder over the three trimesters. Independent demographic predictors were youth and unemployment (P<05). Planned pregnancy, exercising, not smoking, being married and support from physician and family were protective factors (P<.05). Using a multivariable model, prior history of depression was the strongest predictor of depression during pregnancy. Of those taking medication for depression prior to pregnancy, only 1.6% remained on medication during the pregnancy. CONCLUSIONS: Poverty-related factors and lifestyle are associated with higher EPDS scores during pregnancy in Jamaican women. A protocol of psychosocial management in obstetric care is discussed along with recommendations for future research.

Children's experience of loss by parental migration in inner-city Jamaica.

Migratory separation, when parents migrate and leave their children behind, was investigated in a case-control sample of 9- to 10-year-olds living in inner-city communities in Kingston and St Andrew, Jamaica (N = 54). Data analyses using descriptive statistics and bivariate correlations showed that children's reactions to their parents' migration were directly related to poor school performance and psychological difficulties. Additionally, being currently exposed to violence in the home and/or community was significantly associated with high scores on a measure of grief intensity. "Protective" factors included having someone to talk to about the migration and living in a supportive family. Migratory separation needs detailed investigation like that devoted to other childhood family disruptions, such as parental divorce or death.

Children's response to hospitalization at the University Hospital of the West Indies

The results of this study indicated that patients aged 3-13 years who had a history of previous hospitalization appeared to be significantly more distressed than patients without such previous history (p<0.05). Previously hospitalized children were more uncooperative and displayed anxious, immature behaviour patterns. Children who were hospitalized for more than a month were also interviewed about their concerns and response to hospitalization. The study highlighted the need for hospitalized children to be better prepared for hospitalization, to have greater parental involvement in the management of their behaviour and to have efficiently run programmes geared at addressing their educational and emotional needs.